JP6952204B2 - Control device, residual heat determination method, and residual heat determination program - Google Patents

Description

The present invention relates to a control device , a residual heat determination method, and a residual heat determination program.

Conventionally, a medical device for treating a target site in a living tissue (hereinafter referred to as a target site) by applying treatment energy from an end effector to the target site (hereinafter referred to as a target site) has been known (for example, Patent Document). 1).
In the medical device described in Patent Document 1, the end effector includes a heater that generates heat in response to power supply and a pair of high-frequency electrodes. Then, in the medical device, heat energy, which is treatment energy, is applied from the end effector to the target site by supplying electric power to the heater. Further, in the medical device, high frequency energy, which is treatment energy, is applied from the end effector to the target site by supplying electric power between the pair of high frequency electrodes.

International Publication No. 2013/088891

By the way, the first temperature required for sealing the target site is lower than the second temperature required for incising the target site.
Then, when the target site is incised using the medical device described in Patent Document 1 and then another target site different from the target site is sealed, the following problems may occur.
When electric power for incising the target site is supplied to the end effector by heating the target site at a second temperature, the end effector is in a state of high residual heat level after the incision is completed. It has become. In this state, when power for sealing the other target part is supplied to the end effector by heating another target part different from the target part at the first temperature, the end effector Since the residual heat level is high, there is a problem that the other target portion is overheated at a temperature equal to or higher than the first temperature.

The present invention has been made in view of the above, and an object of the present invention is to provide a control device capable of avoiding overheating of a living tissue, a residual heat determination method, and a residual heat determination program.

To solve the above problems and achieve the object, a control apparatus according to the present invention is used to treat energy for treating raw body tissue with the treatment instrument having an end effector that imparts respect to the biological tissue A control device , wherein the control device supplies power for sealing the living tissue to the treatment tool by heating the living tissue at a first temperature, and the sealing control mode. By heating the living tissue at a second temperature higher than the first temperature, at least an incision control mode in which power for incising the living tissue is supplied to the treatment tool can be executed. One processor is provided, and the processor calculates the elapsed time after the end effector reaches the second temperature as an index value as an index of the temperature of the end effector by executing the incision control mode. Then, the index value and the threshold value are compared, and the residual heat level of the end effector is determined based on the comparison result between the index value and the threshold value.

The residual heat determination method according to the present invention is a residual heat determination method executed by a processor of a control device , and the processor is for sealing the biological tissue by heating the biological tissue at a first temperature. A sealing control mode in which power is supplied to the treatment tool, and power for incising the living tissue by heating the living tissue at a second temperature higher than the first temperature is applied to the treatment tool. Each of the incision control modes supplied to the treatment tool can be executed, and the residual heat determination method is performed after the end effector provided on the treatment tool reaches the second temperature by executing the incision control mode. elapsed time was calculated as the index value indicative of the temperature of the end effector, comparing the index value with the threshold value, based on a result of comparison between the index value and the threshold, Zan'netsu level of the end effector of To judge.

The residual heat determination program according to the present invention is a residual heat determination program executed by a processor of a control device , and the processor is for sealing the biological tissue by heating the biological tissue at a first temperature. A sealing control mode in which power is supplied to the treatment tool, and power for incising the living tissue by heating the living tissue at a second temperature higher than the first temperature is applied to the treatment tool. Each of the incision control modes supplied to the device can be executed, and the residual heat determination program instructs the processor to execute the following: By executing the incision control mode, an end effector provided on the treatment tool is provided. There was calculated as an index value which is a temperature index of the end effector an elapsed time after becoming the second temperature, and comparing the index value with the threshold value, the comparison result between the index value and the threshold value Based on this, the residual heat level of the end effector is determined.

According to the control device , the residual heat determination method, and the residual heat determination program according to the present invention, overheating of the living tissue can be avoided.

FIG. 1 is a diagram showing a treatment system according to the present embodiment. FIG. 2 is a diagram showing a grip portion. FIG. 3 is a block diagram showing the configuration of the control device. FIG. 4 is a flowchart showing a residual heat determination method. FIG. 5 is a flowchart showing a residual heat determination method. FIG. 6 is a diagram showing the behavior of the impedance of the target portion when the residual heat determination method is executed. FIG. 7 is a diagram illustrating a method for determining the type of the target portion. FIG. 8 is a diagram illustrating a method for determining the type of the target portion. FIG. 9 is a flowchart showing the first phase of high frequency control. FIG. 10 is a diagram showing the behavior of the output power, the output voltage, and the impedance of the living tissue at the time of executing the first phase. FIG. 11 is a flowchart showing the second phase of high frequency control. FIG. 12 is a diagram illustrating a method for determining the size of the target portion. FIG. 13 is a diagram illustrating a method for determining the size of the target portion. FIG. 14 is a flowchart showing thermal control. FIG. 15 is a diagram showing a modified example 1 of the present embodiment. FIG. 16 is a diagram showing a modified example 1 of the present embodiment. FIG. 17 is a diagram showing a modification 2 of the present embodiment. FIG. 18 is a diagram showing a modified example 3 of the present embodiment.

Hereinafter, embodiments for carrying out the present invention (hereinafter referred to as embodiments) will be described with reference to the drawings. The present invention is not limited to the embodiments described below. Further, in the description of the drawings, the same parts are designated by the same reference numerals.

[Outline configuration of treatment system]
FIG. 1 is a diagram showing a treatment system 1 according to the present embodiment.
The treatment system 1 corresponds to the medical device according to the present invention. This treatment system 1 treats the target site by applying treatment energy to the target site (hereinafter referred to as the target site) in the living tissue. Here, in the present embodiment, high frequency energy and thermal energy are adopted as the treatment energy. Further, the treatments that can be performed by the treatment system 1 are two treatments, a first treatment for incising the target site and a second treatment for sealing the target site.
As shown in FIG. 1, the treatment system 1 includes a treatment tool 2 and a control device 3.

[Structure of treatment tool]
The treatment tool 2 is, for example, a surgical treatment tool for treating a target site while passing through the abdominal wall. As shown in FIG. 1, the treatment tool 2 includes a handle 5, a shaft 6, and a grip portion 7.
The handle 5 is a part held by the operator. As shown in FIG. 1, the handle 5 is provided with an operation knob 51 and an interface 52.
The interface 52 is provided so as to be exposed to the outside from the handle 5, and receives an operation of setting the incision control mode and the sealing control mode by the operator. As shown in FIG. 1, the interface 52 includes first and second switches 521 and 522.
The first switch 521 accepts an incision control mode setting operation by the operator. Then, the first switch 521 outputs an operation signal corresponding to the setting operation to the control device 3 via the electric cable C (FIG. 1).
The second switch 522 accepts the operation of setting the sealing control mode by the operator. Then, the second switch 522 outputs an operation signal corresponding to the setting operation to the control device 3 via the electric cable C.

The shaft 6 has a substantially cylindrical shape, and one end thereof is connected to the handle 5 (FIG. 1). A grip portion 7 is attached to the other end of the shaft 6. Inside the shaft 6, an opening / closing mechanism (illustrated) that opens and closes the first and second gripping members 8 and 9 (FIG. 1) constituting the gripping portion 7 in response to the operation of the operation knob 51 by the operator. (Omitted) is provided. Further, inside the shaft 6, an electric cable C (FIG. 1) is arranged from one end side to the other end side by passing through the handle 5.

[Structure of grip]
The "tip side" described below is the tip side of the grip portion 7 and means the left side in FIG. Further, the "base end side" described below is the shaft 6 side of the grip portion 7, and means the right side in FIG.
FIG. 2 is a diagram showing a grip portion 7.
The grip portion 7 is a portion that treats the target portion while gripping the target portion, and corresponds to the end effector according to the present invention. As shown in FIG. 1 or 2, the grip portion 7 includes first and second grip members 8 and 9.
The first and second gripping members 8 and 9 are configured to be openable and closable in the direction of arrow R1 (FIG. 2) in response to the operation of the operation knob 51 by the operator.

[Structure of the first gripping member]
The first gripping member 8 is arranged at a position facing the second gripping member 9. As shown in FIG. 2, the first gripping member 8 includes a first jaw 10, a first support member 11, and a treatment portion 12.
The first jaw 10 is a portion of the shaft 6 extending toward the tip end side, and is formed in a long shape extending in the longitudinal direction from the tip end of the grip portion 7 toward the base end. The first jaw 10 is made of a metal material such as stainless steel or titanium. Then, the first jaw 10 supports the first support member 11 and the treatment portion 12.
The first support member 11 is a long flat plate extending in the longitudinal direction of the grip portion 7, and is made of a resin material having a low thermal conductivity such as PEEK (polyetheretherketone). .. Then, the first support member 11 is arranged between the first jaw 10 and the treatment portion 12.

The treatment unit 12 generates high frequency energy and thermal energy under the control of the control device 3. As shown in FIG. 2, the treatment unit 12 includes a heat transfer plate 13 and a heater 14 (see FIG. 3).
The heat transfer plate 13 is a flat plate extending in the longitudinal direction of the grip portion 7, and is made of, for example, a conductive material such as copper.
In the heat transfer plate 13, the surface on the side of the second gripping member 9 comes into contact with the target portion while the target portion is gripped by the first and second gripping members 8 and 9. Then, the surface transfers the heat from the heater 14 to the target portion. That is, the surface functions as a first gripping surface 131 (FIG. 2) that applies thermal energy to the target portion. In the present embodiment, the first gripping surface 131 is in a direction in which the first and second gripping members 8 and 9 face each other in a state where the target portion is gripped by the first and second gripping members 8 and 9. It is composed of flat surfaces orthogonal to A1 (FIG. 2). Further, in the heat transfer plate 13, the back surface 132 forming the front and back surfaces of the first gripping surface 131 is also formed of a flat surface orthogonal to the direction A1.
Further, one high frequency lead wire C1 of a pair of high frequency lead wires C1 and C1'(see FIG. 3) constituting the electric cable C is connected to the heat transfer plate 13.
The first gripping surface 131 and the back surface 132 are each formed of a flat surface, but the present invention is not limited to this, and other shapes such as a convex shape and a concave shape may be formed. The same applies to the second gripping surface 931 described later.

The heater 14 is, for example, a seat heater, and is arranged on the back surface 132 of the heat transfer plate 13. Although the specific illustration is omitted, the heater 14 has an electric resistance pattern formed by vapor deposition or the like on a sheet-like substrate formed of an insulating material such as polyimide.
The electric resistance pattern is formed, for example, along a U-shape that follows the outer edge shape of the heater 14. Further, a pair of heat generating lead wires C2 and C2'(see FIG. 3) constituting the electric cable C are connected to both ends of the electric resistance pattern. Further, electric power is supplied to the electric resistance pattern by passing through a pair of heat generating lead wires C2 and C2'under the control of the control device 3. As a result, the electric resistance pattern generates heat.

[Structure of second gripping member]
As shown in FIG. 2, the second gripping member 9 includes a second jaw 91, a second support member 92, and a facing plate 93.
The second jaw 91 has an elongated shape extending in the longitudinal direction of the grip portion 7. Then, the base end side of the second jaw 91 is rotatably supported with respect to the shaft 6 about the fulcrum P0 (FIG. 2), and opens and closes with respect to the first gripping member 8 by rotating. ..
In the present embodiment, the first gripping member 8 (first jaw 10) is fixed to the shaft 6, and the second gripping member 9 (second jaw 91) is pivotally supported by the shaft 6. However, it is not limited to this. For example, a configuration may be adopted in which both the first and second gripping members 8 and 9 are pivotally supported by the shaft 6 and the first and second gripping members 8 and 9 are opened and closed by rotating each of them. No. Further, for example, the first gripping member 8 is pivotally supported by the shaft 6, the second gripping member 9 is fixed to the shaft 6, and the first gripping member 8 rotates to the second gripping member 9. On the other hand, a configuration that opens and closes may be adopted.

The second support member 92 is made of a resin material having a low thermal conductivity such as PEEK, and is arranged between the second jaw 91 and the facing plate 93.
The facing plate 93 is made of a conductive material such as copper, and is fixed on a surface of the second supporting member 92 facing the first gripping member 8.
In the facing plate 93, the surface on the side of the first gripping member 8 functions as a second gripping surface 931 that grips the target portion with the first gripping surface 131. Further, the other high frequency lead wire C1'is connected to the facing plate 93.

[Control device configuration]
FIG. 3 is a block diagram showing the configuration of the control device 3.
The control device 3 comprehensively controls the operation of the treatment tool 2 via the electric cable C. As shown in FIG. 3, the control device 3 includes a high-frequency energy output unit 31, a first sensor 32, a thermal energy output unit 33, a second sensor 34, a notification unit 35, a processor 36, and the like. It includes a memory 37.
The high-frequency energy output unit (generator) 31 supplies high-frequency power to the heat transfer plate 13 and the facing plate 93 via a pair of high-frequency lead wires C1 and C1'under the control of the processor 36. As a result, a high-frequency current flows through the target portion gripped between the heat transfer plate 13 and the facing plate 93. In other words, high frequency energy is applied to the target portion gripped between the heat transfer plate 13 and the facing plate 93. That is, the heat transfer plate 13 and the facing plate 93 function as high-frequency electrodes according to the present invention, respectively.
The first sensor 32 detects the voltage value and the current value supplied from the high-frequency energy output unit 31 to the heat transfer plate 13 and the facing plate 93. Then, the first sensor 32 outputs a signal corresponding to the detected voltage value and current value to the processor 36.

The thermal energy output unit (generator) 33 supplies electric power to the electric resistance pattern constituting the heater 14 by passing through a pair of heat generating lead wires C2 and C2'under the control of the processor 36. As a result, the electric resistance pattern generates heat. Then, the heat of the electric resistance pattern is transferred from the heat transfer plate 13 to the target portion gripped between the heat transfer plate 13 and the facing plate 93. In other words, heat energy is applied to the target portion gripped between the heat transfer plate 13 and the facing plate 93.
The second sensor 34 detects the voltage value and the current value supplied from the thermal energy output unit 33 to the heater 14. Then, the second sensor 34 outputs a signal corresponding to the detected voltage value and current value to the processor 36.

The notification unit 35 notifies predetermined information under the control of the processor 36. The notification unit 35 includes, for example, an LED (Light Emitting Diode) that notifies predetermined information by lighting, blinking, or the color when it is lit, a display device that displays predetermined information, and output of predetermined information by voice. An example of a speaker or the like can be used.

The processor 36 is, for example, a CPU (Central Processing Unit), an FPGA (Field-Programmable Gate Array), or the like, and controls the operation of the entire treatment system 1 according to a program stored in the memory 37. The detailed functions of the processor 36 will be described later in "Control method executed by the processor".
The memory 37 stores a program executed by the processor 36 (including a residual heat determination program according to the present invention), information necessary for processing of the processor 36, and the like.

[Control method executed by the processor]
Next, the control method executed by the processor 36 will be described.
Hereinafter, as the control method executed by the processor 36, the residual heat determination method, the high frequency control, and the thermal control will be described in order.

[Residual heat determination method]
First, the residual heat determination method executed by the processor 36 will be described.
4 and 5 are flowcharts showing a residual heat determination method. FIG. 6 is a diagram showing the behavior of the impedance of the target portion when the residual heat determination method is executed. 7 and 8 are diagrams for explaining a method for determining the type of the target site LT. Specifically, FIG. 7 is a diagram schematically showing a state in which the target portion LT is gripped by the heat transfer plate 13 and the facing plate 93. FIG. 8 is a diagram showing the distribution of the initial impedance Z0 in the small S size blood vessel, the large L size blood vessel, and the adipose tissue, respectively.

The surgeon holds the treatment tool 2 by hand and inserts the tip portion (a part of the grip portion 7 and the shaft 6) of the treatment tool 2 into the abdominal cavity after passing through the abdominal wall using, for example, a trocca. Then, the operator grips the target portion LT (FIG. 7) by the grip portion 7 by operating the operation knob 51. In this state, the processor 36 supplies a minute high-frequency power from the high-frequency energy output unit 31 to the heat transfer plate 13 and the facing plate 93 by passing through the pair of high-frequency lead wires C1 and C1'(step S1A). .. As a result, the detection current flows through the target portion LT gripped by the heat transfer plate 13 and the facing plate 93.
Here, the minute high-frequency power means power to the extent that the target portion LT gripped by the heat transfer plate 13 and the facing plate 93 does not undergo thermal denaturation.

After step S1A, the processor 36 starts calculating the impedance of the target portion LT based on the voltage value and the current value detected by the first sensor 32 (step S1B). Then, the processor 36 sequentially stores the calculated impedance of the target portion LT in the memory 37. The impedance of the target portion LT corresponds to the index value and the heat denaturation level according to the present invention. That is, the processor 36 calculates the index value according to the present invention before applying the high-frequency energy to the target portion LT described later (step S2E) and applying the thermal energy to the target portion LT described later (step S3B). doing.
In the following, for convenience of explanation, the impedance of the target portion LT calculated first, that is, the impedance of the target portion LT first stored in the memory 37 is referred to as the initial impedance Z0 (FIG. 6). Further, the calculation of the impedance of the target portion LT and the storage in the memory 37 are continued in the first and second phases described later.
After step S1B, the processor 36 constantly monitors whether or not the operator has set the sealing control mode to the second switch 522 (step S1C).

By the way, the processor 36 executes the following processing when the incision control mode is set to the first switch 521 by the operator.
The processor 36 operates both the high-frequency energy output unit 31 and the thermal energy output unit 33 in order to make an incision in the target portion LT. Then, the high frequency energy output unit 31 supplies relatively high high frequency power to the heat transfer plate 13 and the facing plate 93 by passing through the pair of high frequency lead wires C1 and C1'. Further, the thermal energy output unit 33 supplies a relatively high electric power to the electric resistance pattern constituting the heater 14 by passing through the pair of heat generating lead wires C2 and C2'. As a result, the temperatures of the heat transfer plate 13 and the facing plate 93 rise to a second temperature of, for example, about 300 ° C., which enables the incision of the target portion LT. Further, as time elapses from the time when the execution of the incision control mode is completed, the temperatures of the heat transfer plate 13 and the facing plate 93 decrease.

When there is no residual heat in the heat transfer plate 13 and the facing plate 93, the impedance of the target portion LT does not change from the initial impedance Z0 just by grasping the target portion LT.
On the other hand, when there is residual heat of the heat transfer plate 13 and the facing plate 93, the target portion LT is denatured by the residual heat. That is, as shown in FIG. 6, the impedance of the target portion LT gradually decreases due to the residual heat. Further, when the residual heat is relatively large, the impedance of the target portion LT reaches the minimum value Zmin and then starts to increase.
That is, the residual heat level can be determined by the amount of change Zch (FIG. 6) from the initial impedance Z0.

When the operator sets the sealing control mode to the second switch 522 (step S1C: Yes), the processor 36 executes the sealing control mode.
First, the processor 36 reads out the latest impedance and the initial impedance Z0 from the plurality of impedances of the target portion LT stored in the memory 37. Then, the processor 36 determines whether or not the amount of change Zch from the initial impedance Z0 to the latest impedance is smaller than the residual heat determination threshold value Zj1 (step S1D).

When it is determined that the amount of change Zch is smaller than the residual heat determination threshold value Zj1 (step S1D: Yes), the processor 36 determines that the residual heat levels of the heat transfer plate 13 and the facing plate 93 are “no residual heat”. (Step S1E). Then, the processor 36 stores the determination result in the memory 37. After this, the processor 36 shifts to step S1K.
On the other hand, when it is determined that the amount of change Zch is equal to or greater than the residual heat determination threshold Zj1 (step S1D: No), the processor 36 refers to a plurality of impedances of the target portion LT stored in the memory 37, and refers to the target portion LT. It is determined whether or not the impedance of is reached the minimum value Zmin (step S1F).

When it is determined that the impedance of the target portion LT has reached the minimum value Zmin (step S1F: Yes), the processor 36 determines that the residual heat level of the heat transfer plate 13 and the facing plate 93 is “large” (step). S1G). Then, the processor 36 stores the determination result in the memory 37. After this, the processor 36 shifts to step S1K.
On the other hand, when it is determined that the impedance of the target portion LT has not reached the minimum value Zmin (step S1F: No), the processor 36 determines whether or not the change amount Zch is smaller than the residual heat determination threshold value Zj2. (Step S1H). The residual heat determination threshold value Zj2 is a value larger than the residual heat determination threshold value Zj1.

When it is determined that the amount of change Zch is smaller than the residual heat determination threshold value Zj2 (step S1H: Yes), the processor 36 determines that the residual heat levels of the heat transfer plate 13 and the facing plate 93 are "small" (step). S1I). Then, the processor 36 stores the determination result in the memory 37. After this, the processor 36 shifts to step S1K.
On the other hand, when it is determined that the amount of change Zch is equal to or greater than the residual heat determination threshold value Zj2 (step S1H: No), the processor 36 determines that the residual heat levels of the heat transfer plate 13 and the facing plate 93 are “medium”. (Step S1J). Then, the processor 36 stores the determination result in the memory 37. After this, the processor 36 shifts to step S1K.

As described above, the processor 36 executes the determination of the residual heat level (steps S1E, S1G, S1I, S1J) after the operation of setting the sealing control mode to the second switch 522 (step S1C: Yes). .. That is, in the sealing control mode, the processor 36 performs residual heat before applying high-frequency energy to the target portion LT described later (step S2E) and applying thermal energy to the target portion LT described later (step S3B). The level determination (steps S1E, S1G, S1I, S1J) is executed.

By the way, the initial impedance Z0 of the target portion LT is determined by the following equation (1). In the formula (1), ρ is the resistivity of the target site LT. As shown in FIG. 7, S is the cross-sectional area of the target site LT. d is the thickness of the target site LT.

Here, when the target site LT is adipose tissue, the initial impedance Z0 becomes large because the resistivity ρ is large. When the target site LT is vascular tissue, the resistivity ρ is the same regardless of the size of the vascular tissue. Further, since it is gripped by the heat transfer plate 13 and the facing plate 93, the thickness d is also the same. However, the larger the size of the vascular tissue, the larger the cross-sectional area S, so that the initial impedance Z0 becomes smaller.
That is, if the initial impedance Z0 is larger than the discrimination threshold value R0f (FIG. 8), it is possible to discriminate whether the target site LT is adipose tissue or vascular tissue. However, as shown in FIG. 8, although the initial impedance Z0 tends to decrease as the size of the vascular tissue increases, the initial impedance Z0 overlaps with the distribution of the initial impedance Z0 between the S size blood vessel and the L size blood vessel. Even if Z0 is used, the size of vascular tissue cannot be determined. If a discrimination threshold R01 (FIG. 8) larger than the distribution of the initial impedance Z0 of the L size blood vessel is used, the target site LT having an initial impedance Z0 larger than the discrimination threshold R01 and smaller than the discrimination threshold R0f is clear. It can be determined that it is an S size blood vessel.

Then, the processor 36 executes step S1K shown below.
The processor 36 reads out the initial impedance Z0 stored in the memory 37. Then, the processor 36 determines whether or not the read initial impedance Z0 is larger than the discrimination threshold value R01 and smaller than the discrimination threshold value R0f, that is, whether or not the target site LT is an S size blood vessel.

When it is determined that the target site LT is not an S size blood vessel (step S1K: No), the processor 36 starts high frequency control and thermal control in steps S2 and S3.
On the other hand, when it is determined that the target site LT is an S size blood vessel (step S1K: Yes), the processor 36 refers to the determination result of the residual heat level stored in the memory 37, and based on the determination result, the processor 36 refers to the determination result. It is determined whether or not the residual heat level of the heat transfer plate 13 and the facing plate 93 is “large” (step S1L).

If it is determined that the residual heat level is not "large" (step S1L: No), the processor 36 starts high frequency control and thermal control in steps S2 and S3.
On the other hand, when it is determined that the residual heat level is "large" (step S1L: Yes), the processor 36 causes the notification unit 35 to notify the information indicating the warning (step S1M). That is, when the residual heat level exceeds a specific level, the processor 36 causes the notification unit 35 to notify information indicating a warning. Then, the processor 36 ends this control flow. That is, the processor 36 does not execute the high frequency control and the heat control (steps S2 and S3) by prohibiting the supply of electric power to the grip portion 7 when the residual heat level exceeds a specific level. This makes it possible to appropriately prevent overheating of the S size blood vessel, which is particularly sensitive to temperature.

[High frequency control]
Next, the high frequency control (step S2) executed by the processor 36 will be described. The high frequency control (step S2) is divided into two phases, a first phase and a second phase. Hereinafter, the first and second phases will be described in order as high frequency control (step S2).

[First phase]
FIG. 9 is a flowchart showing the first phase of high frequency control. FIG. 10 is a diagram showing the behavior of the output power, the output voltage, and the impedance of the target portion LT at the time of executing the first phase. Note that FIG. 10 shows the behavior of the output power, the output voltage, and the impedance of the target portion LT when the residual heat level of the heat transfer plate 13 and the counter plate 93 is “no residual heat” for convenience of explanation. ..
In the first phase, the supply of the output voltage from the high-frequency energy output unit 31 to the heat transfer plate 13 and the counter plate 93 is started, and the output voltage is increased to uniformly heat the target portion LT. It is a phase.

First, the processor 36 reads out the initial impedance Z0 stored in the memory 37. Then, the processor 36 determines whether or not the read initial impedance Z0 is larger than the discrimination threshold value R0f, that is, whether or not the target site LT is adipose tissue (step S2A).

When it is determined that the target site LT is not adipose tissue (step S2A: No), the processor 36 sets the minimum output time for applying high frequency energy to the target site LT to 600 [msec] in the first phase. (Step S2B). After this, the processor 36 shifts to step S2D.
On the other hand, when it is determined that the target site LT is adipose tissue (step S2A: Yes), the processor 36 sets the minimum output time of applying high frequency energy to the target site LT to 1000 [in the first phase. msec] is set (step S2C). After this, the processor 36 shifts to step S2D.
In steps S2B and S2C, the minimum output time is not limited to the above-mentioned time as long as the minimum output time set by step S2C is larger than the minimum output time set by step S2B.

Then, the processor 36 executes the step S2D shown below.
In the first phase, the processor 36 sets the slope of the increase in the output voltage supplied from the high-frequency energy output unit 31 to the heat transfer plate 13 and the facing plate 93.
By the way, in the first phase, if the output voltage supplied from the high frequency energy output unit 31 to the heat transfer plate 13 and the facing plate 93 is suddenly increased, the temperature of the target portion LT is rapidly increased. That is, the target portion LT cannot be heated uniformly. Then, the temperature unevenness of the target portion LT deteriorates the sealing performance of the target portion LT.

Therefore, in step S2D, the processor 36 has an output voltage proportional to the reciprocal of the initial impedance Z0 and the reciprocal of the residual heat level, based on the initial impedance Z0 stored in the memory 37 and the determination result of the residual heat level. Set the slope of the rise of. That is, since the processor 36 is more sensitive to the temperature rise as the target portion LT is smaller, the slope of the rise in the output voltage is set more gently as the target portion LT is smaller. Although the size of the vascular tissue cannot be identified only by the initial impedance Z0, it is a fact that the initial impedance Z0 of the S size blood vessel is larger than that of the L size blood vessel (FIG. 8). Therefore, the processor 36 sets the slope of the rise of the output voltage more gently as the initial impedance Z0 becomes larger. Further, in order to avoid a sudden temperature rise of the target portion LT due to the residual heat of the heat transfer plate 13 and the facing plate 93, the processor 36 sets the slope of the rise of the output voltage more gently as the residual heat level is higher. That is, the higher the residual heat level, the more the processor 36 suppresses the power supplied to the heat transfer plate 13 and the facing plate 93. Further, in the sealing control mode, the processor 36 adjusts the electric power supplied to the heat transfer plate 13 and the facing plate 93 based on the determination result of the residual heat level. Here, the slope of the increase in the output voltage corresponds to the control target value according to the present invention. That is, the processor 36 changes the control target value according to the present invention based on the determination result of the residual heat level.

After step S2D, the processor 36 starts supplying the output voltage from the high frequency energy output unit 31 to the heat transfer plate 13 and the facing plate 93 (step S2E). That is, the application of high frequency energy to the target portion LT is started. The output voltage supplied at the beginning is the same initial voltage V0 (FIG. 10) regardless of the type and size of the target portion LT. As a result, a high-frequency current flows through the target site LT, and the target site LT is heated.

After step S2E, the processor 36 calculates the output power supplied from the high-frequency energy output unit 31 to the heat transfer plate 13 and the counter plate 93 based on the voltage value and the current value detected by the first sensor 32. Is started (step S2F). Then, the processor 36 sequentially stores the calculated output power in the memory 37.
After step S2F, the processor 36 refers to the slope of the rise in output voltage set in step S2D, and as shown in FIG. 10, the output voltage supplied from the high-frequency energy output unit 31 to the heat transfer plate 13 and the counter plate 93. (Step S2G).

Here, the behavior of the impedance of the target portion LT after the start of applying the high frequency energy (step S2E) is as shown in FIG.
That is, the impedance of the target site LT decreases when the target site LT is heated, and takes a minimum value Zmin when the water content of the target site LT reaches a boiling state. Further, the impedance of the target portion LT starts to increase because the water content of the target portion LT evaporates when the heating of the target portion LT is further continued.
That is, when the increase value VI (FIG. 10) of the impedance of the target portion LT from the minimum value Zmin exceeds a predetermined threshold value, it can be determined that the state has shifted from the heated state to the dry state.

After step S2G, the processor 36 reads out the minimum value Zmin and the latest impedance among the plurality of impedances of the target portion LT stored in the memory 37. Then, the processor 36 determines whether or not the rising value VI from the minimum value Zmin to the latest impedance exceeds a predetermined threshold value (step S2H).
When it is determined that the increase value VI does not exceed a predetermined threshold value (step S2H: No), the processor 36 returns to step S2G.
On the other hand, when it is determined that the rising value VI exceeds a predetermined threshold value (step S2H: Yes), the processor 36 starts applying high frequency energy (step S2E), and the elapsed time from the start (step S2E) is determined by steps S2B and S2C. It is determined whether or not the set minimum output time has been exceeded (step S2I).

If it is determined that the elapsed time does not exceed the minimum output time (step S2I: No), the processor 36 returns to step S2G.
On the other hand, when it is determined that the elapsed time exceeds the minimum output time (step S2I: Yes), the processor 36 ends the first phase and shifts to the second phase.

[Second phase]
FIG. 11 is a flowchart showing the second phase of high frequency control. 12 and 13 are diagrams illustrating a method for determining the size of the target portion LT. Specifically, FIG. 12 is a diagram showing the distribution of the minimum value Zmin in the S size blood vessel and the L size blood vessel, respectively. FIG. 13 is a diagram showing the distribution of the peak value Pp of the output power in the S size blood vessel and the L size blood vessel, respectively.
The second phase is a phase in which the target portion LT is dried to a deep part by making the output voltage supplied from the high frequency energy output unit 31 to the heat transfer plate 13 and the facing plate 93 constant.

First, the processor 36 reads out the initial impedance Z0 stored in the memory 37. Then, the processor 36 determines whether or not the read initial impedance Z0 is larger than the discrimination threshold value R0f (step S2J).
When it is determined that the initial impedance Z0 is larger than the discrimination threshold value R0f (step S2J: Yes), the processor 36 determines that the target site LT is adipose tissue (step S2K). Then, the processor 36 stores the determination result (hereinafter, described as the organization determination result) in the memory 37. After this, the processor 36 shifts to step S2R.
On the other hand, when it is determined that the initial impedance Z0 is equal to or less than the discrimination threshold R0f (step S2J: No), the processor 36 refers to the determination result of the residual heat level stored in the memory 37, and based on the determination result. , It is determined whether or not the residual heat level of the heat transfer plate 13 and the facing plate 93 is "large" (step S2L).

By the way, as described above, it is not possible to determine whether the blood vessel is an S size blood vessel or an L size blood vessel at the initial impedance Z0. As for the minimum value Zmin, as shown in FIG. 12, the larger the size of the vascular tissue, the smaller the minimum value Zmin tends to be, but it overlaps with the distribution of the minimum value Zmin between the S size blood vessel and the L size blood vessel. Therefore, even if the minimum value Zmin is used, the size of the vascular tissue cannot be determined.
Here, it is experimentally known that the size of the vascular tissue can be discriminated by using the peak value Pp (FIG. 10) of the output power in the first phase. That is, as shown in FIG. 13, if the peak value Pp is smaller than the discrimination threshold value Pj, it can be determined that the target site LT is an S size blood vessel. On the other hand, if the peak value Pp is equal to or higher than the discrimination threshold value Pj, it can be determined that the target site LT is an L size blood vessel. The peak value Pp includes information on both the minimum value Zmin and the time until the minimum value Zmin is reached (magnitude of output voltage). The reason why the size of the vascular tissue can be determined by the peak value Pp is that the parameter includes not only the impedance in the boiling state (minimum value Zmin) but also information such as the time until the boiling state is reached. Infer.

When it is determined that the residual heat level is not "large" (step S2L: No), the processor 36 reads out the peak value Pp among the plurality of output powers stored in the memory 37. Then, the processor 36 determines whether or not the read peak value Pp is smaller than the discrimination threshold value Pj (step S2M).

When it is determined that the peak value Pp is smaller than the discrimination threshold value Pj (step S2M: Yes), the processor 36 determines that the target site LT is an S size blood vessel (step S2N). Then, the processor 36 stores the determination result (hereinafter, described as the organization determination result) in the memory 37. After this, the processor 36 shifts to step S2R.
On the other hand, when it is determined that the peak value Pp is equal to or greater than the discrimination threshold Pj (step S2M: No), the processor 36 determines that the target site LT is an L size blood vessel (step S2O). Then, the processor 36 stores the determination result (hereinafter, described as the organization determination result) in the memory 37. After this, the processor 36 shifts to step S2R.

On the other hand, when it is determined that the residual heat level is "large" (step S2L: Yes), the processor 36 reads out the initial impedance Z0 out of the plurality of impedances of the target portion stored in the memory 37. Then, the processor 36 determines whether or not the read initial impedance Z0 is larger than the discrimination threshold value R01 (step S2P).

When it is determined that the initial impedance Z0 is larger than the discrimination threshold value R01 (step S2P: Yes), the processor 36 determines that the target site LT is an S size blood vessel (step S2Q). Then, the processor 36 stores the determination result (hereinafter, described as the organization determination result) in the memory 37. After this, the processor 36 shifts to step S2R.
On the other hand, when it is determined that the initial impedance Z0 is equal to or less than the discrimination threshold value R01 (step S2P: No), the processor 36 proceeds to step S2O and determines that the target site LT is an L size blood vessel.
That is, when the residual heat level of the heat transfer plate 13 and the facing plate 93 is "large", the processor 36 determines the size of the vascular tissue by using the initial impedance Z0 instead of the peak value Pp.
In step S2P, the size of the vascular tissue was determined by comparing the initial impedance Z0 with the discrimination threshold value R01, but the present invention is not limited to this. For example, when both the first condition that the initial impedance Z0 is larger than the discrimination threshold value R01 and the second condition that the minimum value Zmin is larger than the predetermined threshold value are satisfied, the target site LT is an S size blood vessel. If both of the first and second conditions are not satisfied, it may be determined that the target site LT is an L size blood vessel.

Then, the processor 36 executes the step S2R shown below.
The processor 36 refers to the determination result of the residual heat level stored in the memory 37, the determination result of the tissue, and the first reference information stored in advance in the memory 37, and sets the high frequency control parameter in the second phase. do. As the first reference information, for example, the information shown in Table 1 below can be exemplified.

As shown in Table 1, the first reference information includes the determination result of the residual heat level (“no residual heat”, “small”, “medium”, and “large”) and the determination result of the tissue (“adipose tissue”). , "L size blood vessel", and "S size blood vessel") and the high frequency control parameter in the second phase.
Here, as shown in Table 1, the high-frequency control parameters in the second phase are the threshold value Radd [Ω], the output time [msec] for executing the constant voltage control (step S2S) described later, and the output voltage [V]. There are three parameters. The threshold value Radd is a threshold value to be compared with the increase value of the impedance of the target portion LT after starting the constant voltage control (step S2S) described later. As shown in Table 1, the output voltage [V] increases as the determination result of the residual heat level becomes "no residual heat", "small", "medium", and "large", that is, the residual heat level becomes. The higher the value, the smaller the value is set. That is, the higher the residual heat level, the more the processor 36 suppresses the power supplied to the heat transfer plate 13 and the facing plate 93. Further, in the sealing control mode, the processor 36 adjusts the electric power supplied to the heat transfer plate 13 and the facing plate 93 based on the determination result of the residual heat level. The high frequency control parameter corresponds to the control target value according to the present invention. That is, the processor 36 changes the control target value according to the present invention based on the determination result of the residual heat level. Further, when the determination result of the residual heat level is "large" and the determination result of the tissue is "S size blood vessel", the information indicating a warning is notified in step S1M, and the high frequency energy is transmitted to the target site LT. Is not given, so the values of the three high frequency control parameters are not set.

The values of the threshold value Radd, the output time, and the output voltage are not limited to the values shown in Table 1, and the determination result of the residual heat level is "large", "medium", "small", and "no residual heat". It should not become smaller as the residual heat level becomes lower, that is, it should become larger as the tissue discrimination result becomes "adipose tissue", "L size blood vessel", and "S size blood vessel". For example, other values may be adopted.
Then, in step S2R, when the determination result of the residual heat level is "large" and the determination result of the tissue is "L size blood vessel", the processor 36 sets the threshold value Radd to 290 [Ω]. Then, the output time is set to 2600 [msec] and the output voltage is set to 40 [V].

After step S2R, the processor 36 executes constant voltage control in which the output voltage set in step S2R is supplied from the high frequency energy output unit 31 to the heat transfer plate 13 and the facing plate 93 (step S2S).
After step S2S, the processor 36 reads out the impedance at the start of the constant voltage control (step S2S) and the latest impedance among the plurality of impedances of the target portion LT stored in the memory 37. Then, the processor 36 determines whether or not the rising value from the impedance at the start time to the latest impedance exceeds the threshold value Radd set in step S2R (step S2T).
When it is determined that the rising value does not exceed the threshold value Radd (step S2T: No), the processor 36 returns to step S2S and continues the constant voltage control.
On the other hand, when it is determined that the rising value exceeds the threshold value Radd (step S2T: Yes), the processor 36 sets the output time set in step S2R as the elapsed time from the start of the constant voltage control (step S2S). It is determined whether or not the value has been exceeded (step S2U).

When it is determined that the elapsed time does not exceed the output time (step S2U: No), the processor 36 returns to step S2S and continues the constant voltage control.
On the other hand, when it is determined that the elapsed time exceeds the output time (step S2U: Yes), the processor 36 stops the supply of the output voltage from the high frequency energy output unit 31 to the heat transfer plate 13 and the facing plate 93 (step S2U: Yes). Step S2V). Then, the processor 36 ends this control flow.

[Heat control]
Next, the thermal control (step S3) executed by the processor 36 will be described. The thermal control (step S3) is executed at the same time as the high frequency control (step S2) described above.
FIG. 14 is a flowchart showing thermal control.
First, the processor 36 refers to the determination result of the residual heat level stored in the memory 37 and the second reference information stored in advance in the memory 37, and sets the thermal control parameter (step S3A). As the second reference information, for example, the information shown in Table 2 below can be exemplified.

As shown in Table 2, the second reference information was associated with the determination result of the residual heat level (“no residual heat”, “small”, “medium”, and “large”) and the thermal control parameters. Information.
Here, as shown in Table 2, the thermal control parameter is a delay time [s] that delays the start time of applying thermal energy (step S3B), which will be described later. The thermal control parameter corresponds to the control target value according to the present invention. That is, the processor 36 changes the control target value according to the present invention based on the determination result of the residual heat level. When the determination result of the residual heat level is "large", the information to "do not output" is set because the application of thermal energy (step S3B) described later is not executed.
The value of the delay time is not limited to the value shown in Table 2, and as the determination result of the residual heat level becomes "large", "medium", "small", and "no residual heat", that is, the residual heat Other values may be adopted as long as the heat level decreases and does not increase.
Then, in step S3A, the processor 36 sets the delay time to 1 [s], for example, when the determination result of the residual heat level is “medium”.

After step S3A, the processor 36 refers to the thermal control parameters set in step S3A and starts supplying the output voltage from the thermal energy output unit 33 to the electric resistance pattern constituting the heater 14 (step S3B). That is, the application of thermal energy to the target portion LT is started. As a result, heat is transferred from the heat transfer plate 13 to the target portion LT, and the target portion LT is heated.

Specifically, the processor 36 executes the following processing in step S3B.
The processor 36 calculates the resistance value of the electric resistance pattern constituting the heater 14 based on the voltage value and the current value detected by the second sensor 34. Further, the processor 36 converts the resistance value of the electric resistance pattern into a temperature (hereinafter referred to as a heater temperature) by using the relationship between the resistance value of the electric resistance pattern and the temperature calculated in advance by an experiment. Then, the processor 36 supplies the output voltage required for setting the heater temperature to the target temperature from the thermal energy output unit 33 to the electric resistance pattern while grasping the heater temperature. That is, the processor 36 executes feedback control.
Here, the processor 36 determines that the residual heat level is "no residual heat" or "small", and the thermal control parameter (delay time) set in step S3A is 0 [s]. At the initial start point, the application of thermal energy to the target site LT is started. Further, when the determination result of the residual heat level is "medium" and the thermal control parameter (delay time) set in step S3A is 1 [s], the processor 36 is 1 [s] from the initial start time. From the time when it is delayed by s], the application of thermal energy to the target site LT is started. Further, when the determination result of the residual heat level is "large" and the heat control parameter (delay time) set in step S3A is information that "does not output", the processor 36 sets the target portion LT. On the other hand, no heat energy is applied. That is, the processor 36 does not execute step S3B.

After step S3B, the processor 36 constantly monitors whether or not the termination condition of the high frequency control (step S2) is satisfied (step S3C). In other words, the processor 36 constantly monitors whether or not it is determined as "Yes" in step S2U described above.
Then, the processor 36 continues to apply the thermal energy to the target portion LT until it is determined that the end condition of the high frequency control (step S2) is satisfied (step S3C: Yes). When it is determined that the end condition of the high frequency control (step S2) is satisfied (step S3C: Yes), the processor 36 transfers the output voltage from the thermal energy output unit 33 to the electric resistance pattern constituting the heater 14. The supply is stopped (step S3D). Then, the processor 36 ends this control flow.
By the above high frequency control (step S2) and thermal control (step S3), the target portion LT is heated at a first temperature of, for example, about 100 ° C. to 200 ° C. required for sealing. As a result, the target site LT is sealed.

According to the present embodiment described above, the following effects are obtained.
In the treatment system 1 according to the present embodiment, the processor 36 uses the temperature index of the heat transfer plate 13 and the counter plate 93 as an index before applying the high frequency energy and the thermal energy to the target portion LT (steps S2E and S3B). The impedance of the target portion LT is calculated (step S1B). Further, the processor 36 determines the residual heat level of the heat transfer plate 13 and the facing plate 93 based on the impedance of the target portion LT (steps S1E, S1G, S1I, S1J). Then, the processor 36 notifies the information indicating the warning from the notification unit 35 (step S1M) based on the determination result of the residual heat level, and adjusts the power supplied to the grip unit 7 (steps S2D, S2R). , S3A).
Therefore, when the target portion LT is sealed in a state where the residual heat level of the heat transfer plate 13 and the facing plate 93 is high, it is possible to prevent the target portion LT from being overheated. That is, it is possible to avoid heat invasion of the living tissue, erroneous incision of the target site LT, adverse effects on the sealing performance of the target site LT, and the like.

In particular, the impedance of the target portion LT is adopted as an index value that is an index of the temperature of the heat transfer plate 13 and the facing plate 93.
Therefore, as compared with a configuration in which the residual heat level is determined based on, for example, the heater temperature, the degree of influence (heat denaturation level) of the target portion LT due to the residual heat of the heat transfer plate 13 and the facing plate 93 is actually determined by the target portion LT. It can be confirmed by the impedance of. That is, it is possible to appropriately determine whether or not the target site LT is overheated.

In the treatment system 1 according to the present embodiment, the processor 36 determines the residual heat level (steps S1E, S1G, S1I) after the operation of setting the sealing control mode to the second switch 522 (step S1C: Yes). , S1J). That is, in the sealing control mode, the processor 36 determines the residual heat level (steps S1E, S1G, S1I, S1J) before applying the high-frequency energy and the thermal energy to the target portion LT (steps S2E, S3B). Run.
Therefore, by executing the above-mentioned processing (steps S1M, S2D, S2R, S3A) in the sealing control mode which is easily affected by the residual heat of the heat transfer plate 13 and the facing plate 93, the target portion LT is overheated. It can be appropriately avoided that it is done.

In the treatment system 1 according to the present embodiment, the processor 36 suppresses the power supplied to the heat transfer plate 13 and the facing plate 93 as the residual heat level is higher (steps S2D and S2R). Further, in the sealing control mode, the processor 36 adjusts the power supplied to the heat transfer plate 13 and the facing plate 93 based on the determination result of the residual heat level (steps S2D and S2R).
Therefore, it is possible to appropriately prevent the target site LT from being overheated.

In the treatment system 1 according to the present embodiment, the processor 36 causes the notification unit 35 to notify information indicating a warning when the residual heat level exceeds a specific level. Further, the processor 36 prohibits the supply of electric power to the grip portion 7.
Therefore, the target site LT is overheated while making the operator aware that high frequency energy and thermal energy cannot be applied to the target site LT because the target site LT is overheated. It is possible to surely avoid being done.

In the treatment system 1 according to the present embodiment, the processor 36 applies a detection current to the target site LT to cause the type and size of the target site LT (“adipose tissue”, “S size blood vessel”, “L”. "Size blood vessel") is determined (steps S2K, S2N, S2O). Then, the processor 36 adjusts the power supplied to the heat transfer plate 13 and the facing plate 93 based on the determination result of the residual heat level and the determination result of the structure (step S2R).
Therefore, it is possible to appropriately avoid overheating of the S size blood vessel, which is particularly sensitive to temperature.

(Other embodiments)
Although the embodiments for carrying out the present invention have been described so far, the present invention should not be limited only to the above-described embodiments.
15 and 16 are diagrams showing a modification 1 of the present embodiment. Specifically, FIG. 15 is a diagram showing the behavior of the heater temperature during and after the execution of the incision control mode. FIG. 16 is a diagram showing a threshold value used for determining the residual heat level.
In the above-described embodiment, the residual heat determination method for determining the residual heat level of the heat transfer plate 13 and the facing plate 93 is not limited to the control flow shown in FIGS. 4 and 5.
As shown in FIG. 15, the heater temperature gradually rises when the execution of the incision control mode is started. Then, the heater temperature is controlled to a second temperature of about 300 ° C. required for incising the target site LT. Further, when the execution of the incision control mode is completed, the heater temperature decreases as time elapses from the time point T1 (FIG. 15) at the end.
Therefore, the processor 36 measures the elapsed time from the time point T1. Then, when the measured elapsed time exceeds the threshold value Th1 (FIG. 15), the processor 36 determines that the residual heat levels of the heat transfer plate 13 and the facing plate 93 are “no residual heat”. On the other hand, when the measured elapsed time is equal to or less than the threshold value Th1, the processor 36 determines that the residual heat level is “with residual heat”. That is, the processor 36 determines the residual heat level after executing the incision control mode.

In the present modification 1, the elapsed time from T1 at the end of the execution of the incision control mode is measured, but the elapsed time is not limited to this, and the elapsed time after the heater temperature reaches the second temperature is measured. It doesn't matter. Then, the residual heat level may be determined as described above by comparing the elapsed time with the threshold value Th1.
Further, the residual heat level is determined based on the comparison result between the change amount Zch and the residual heat determination thresholds Zj1 and Zj2 described in the above-described embodiment and the comparison result between the elapsed time and the threshold value Th1 in the present modification 1. You may judge. That is, the residual heat determination threshold values Zj1 and Zj2 correspond to the second threshold value according to the present invention. Further, the threshold value Th1 corresponds to the first threshold value according to the present invention.
Further, in the present modification 1, the residual heat level is set to two levels, "without residual heat" and "with residual heat", but the present invention is not limited to this, and the residual heat level can be set by providing a plurality of threshold values Th1. May be set to 3 or more levels. Similarly, in the above-described embodiment, the residual heat level is set to four levels of "no residual heat", "small", "medium", and "large", but the present invention is not limited to this. It may be one, three, or five or more levels.

Here, as the duration of execution of the incision control mode and the number of consecutive executions of the incision control mode increase, as shown by the alternate long and short dash line in FIG. 15, the time point T1 at which the execution of the incision control mode is completed The amount of reduction in the heater temperature from the above is reduced.
Therefore, as shown in FIG. 16, as the threshold value Th1, the larger the threshold value Th1 may be used as the duration of execution of the incision control mode or the number of consecutive executions of the incision control mode.

FIG. 17 is a diagram showing a modification 2 of the present embodiment. Specifically, FIG. 17 is a diagram showing the behavior of the heater temperature when the sealing control mode is executed after the incision control mode is executed.
In the above-described embodiment, the residual heat determination method for determining the residual heat level of the heat transfer plate 13 and the facing plate 93 is not limited to the control flow shown in FIGS. 4 and 5, but the residual heat is based on the heater temperature. The heat level may be determined. That is, the heater temperature corresponds to the index value according to the present invention.
For example, as shown in FIG. 17, after executing the incision control mode, the heater temperature at the time point T2 at which the execution of the sealing control mode is started is about 100 to 200 ° C. required to seal the target site LT. It is assumed that the temperature exceeds 1. In this case, the processor 36 determines that the residual heat level of the heat transfer plate 13 and the facing plate 93 is “with residual heat”. On the other hand, when the heater temperature at the time point T2 is equal to or lower than the first temperature, the processor 36 determines that the residual heat level is "no residual heat".
In this modification 2, the residual heat level is set to two levels, "without residual heat" and "with residual heat". However, by providing a plurality of reference temperatures to be compared with the heater temperature, the residual heat level May be set to 3 or more levels.

FIG. 18 is a diagram showing a modified example 3 of the present embodiment. Specifically, FIG. 18 is a diagram showing the behavior of the heater temperature during execution of the incision control mode.
In the above-described embodiment, as shown in FIG. 18, when the elapsed time from the start of execution of the incision control mode exceeds the threshold value Th2, the target temperature of the heater temperature in the incision control mode is set to about 300 ° C. The second temperature may be changed to a third temperature of about 250 ° C., which is lower than the second temperature.
As a result, the residual heat itself of the heat transfer plate 13 and the facing plate 93 after the execution of the incision control mode is completed can be reduced.

In the above-described embodiment, the second reference information is not limited to the information shown in Table 2, and the information shown in Table 3 below may be adopted.

As shown in Table 3, the second reference information is information in which the determination result of the residual heat level (“no residual heat”, “small”, “medium”, and “large”) is associated with the thermal control parameters. Is.
Here, as shown in Table 3, the thermal control parameter is the duty ratio [%] when the output voltage is supplied from the thermal energy output unit 33 to the electric resistance pattern constituting the heater 14 in step S3B. The thermal control parameter corresponds to the control target value according to the present invention. That is, the processor 36 changes the control target value according to the present invention based on the determination result of the residual heat level. When the determination result of the residual heat level is "large", the information to "do not output" is set because the application of thermal energy (step S3B) is not executed.
The duty ratio value is not limited to the value shown in Table 3, and as the determination result of the residual heat level becomes "large", "medium", "small", and "no residual heat", that is, the residual heat As the heat level decreases, other values may be adopted as long as they do not decrease.

Then, the processor 36 executes the following processing in step S3B.
When the determination result of the residual heat level is "no residual heat" or "small" and the thermal control parameter (duty ratio) set in step S3A is 100 [%], the processor 36 sets the heater temperature. The output voltage required to reach the target temperature is continuously supplied from the thermal energy output unit 33 to the electric resistance pattern constituting the heater 14. Further, when the determination result of the residual heat level is "medium" and the thermal control parameter (duty ratio) set in step S3A is 50 [%], the processor 36 sets the heater temperature as the target temperature. The output voltage required for this purpose is intermittently supplied from the thermal energy output unit 33 to the electric resistance pattern according to the duty ratio. Further, when the determination result of the residual heat level is "large" and the heat control parameter (duty ratio) set in step S3A is information that "does not output", the processor 36 sets the target portion LT. On the other hand, it does not output heat energy. That is, the processor 36 does not execute step S3B.

Further, the second reference information is not limited to the information shown in Tables 2 and 3, and the information shown in Table 4 below may be adopted.

As shown in Table 4, the second reference information is information in which the determination result of the residual heat level (“no residual heat”, “small”, “medium”, and “large”) is associated with the thermal control parameters. Is.
Here, as shown in Table 4, the thermal control parameter is the target temperature [° C.] of the heater temperature used in step S3B. The thermal control parameter corresponds to the control target value according to the present invention. That is, the processor 36 changes the control target value according to the present invention based on the determination result of the residual heat level. When the determination result of the residual heat level is "large", the information to "do not output" is set because the application of thermal energy (step S3B) is not executed.
The target temperature value is not limited to the value shown in Table 4, and the residual heat level is determined as “large”, “medium”, “small”, and “no residual heat”, that is, residual heat. As the heat level decreases, other values may be adopted as long as they do not decrease.

Then, the processor 36 executes the following processing in step S3B.
When the determination result of the residual heat level is "no residual heat" or "small" and the thermal control parameter (target temperature) set in step S3A is 120 [° C.], the processor 36 sets the heater temperature. The output voltage required to set the temperature to 120 [° C.] is supplied from the thermal energy output unit 33 to the electric resistance pattern constituting the heater 14. Further, when the determination result of the residual heat level is "medium" and the thermal control parameter (target temperature) set in step S3A is 80 [° C.], the processor 36 sets the heater temperature to 80 [° C.]. The output voltage required for the above is supplied from the thermal energy output unit 33 to the electric resistance pattern. Further, when the determination result of the residual heat level is "large" and the heat control parameter (target temperature) set in step S3A is information that "does not output", the processor 36 sets the target portion LT. On the other hand, it does not output heat energy. That is, the processor 36 does not execute step S3B.
As described above, the higher the residual heat level, the more the processor 36 suppresses the electric power supplied to the electric resistance pattern constituting the heater 14. Further, in the sealing control mode, the processor 36 adjusts the electric power supplied to the electric resistance pattern based on the determination result of the residual heat level.

In the above-described embodiment, the processor according to the present invention is composed of only one processor 36, but the present invention is not limited to this, and two or more processors may be used.
In the above-described embodiment, after determining the residual heat level (steps S1E, S1G, S1I, S1J), the notification unit 35 may be notified of the information indicating the residual heat level.
In the above-described embodiment, a configuration may be adopted in which at least one of thermal energy and high frequency energy is selected as the treatment energy to be applied to the target site LT based on the determination result of the residual heat level. For example, when the residual heat level is the first level, the processor 36 selects both thermal energy and high frequency energy as the treatment energy to be applied to the target site LT. On the other hand, when the residual heat level is a second level higher than the first level, the processor 36 selects either thermal energy or high frequency energy as the treatment energy to be applied to the target site LT.

In the above-described embodiment, thermal energy and high-frequency energy are used as the treatment energy applied to the target site LT, but the present invention is not limited to this, and ultrasonic energy may be used. In addition, "applying ultrasonic energy to the target site LT" means applying ultrasonic vibration to the target site LT. Here, when the ultrasonic energy is adopted, the following control target values can be exemplified as the control target values to be changed based on the determination result of the residual heat level.
For example, as the control target value, a delay time for delaying the start time of applying ultrasonic energy can be exemplified, similar to the thermal control parameter used in the thermal control (step S3) described in the above-described embodiment. .. Further, for example, as the control target value, the amplitude due to ultrasonic vibration can be exemplified.

1 Treatment system 2 Treatment tool 3 Control device 5 Handle 6 Shaft 7 Grip part 8 First grip member 9 Second grip member 10 First jaw 11 First support member 12 Treatment part 13 Heat transfer plate 14 Heater 31 High frequency Energy output unit 32 First sensor 33 Thermal energy output unit 34 Second sensor 35 Notification unit 36 Processor 37 Memory 51 Operation knob 52 Interface 91 Second jaw 92 Second support member 93 Opposing plate 131 First gripping surface 132 Back side 521 First switch 522 Second switch 931 Second gripping surface A1 direction C Electric cable C1, C1'High frequency lead wire C2, C2' Heat transfer lead wire LT Target part P0 fulcrum Pj discrimination threshold Pp peak value R01, R0f Discrimination threshold R1 Arrow Radd threshold T1 When the execution of the incision control mode is finished T2 When the execution of the sealing control mode is started Th1, Th2 Threshold V0 Initial voltage VI rise value Z0 Initial impedance Zch Change amount Zj1, Zj2 Remaining Thermal judgment threshold Zmin minimum value

Claims (18)

Treatment energy for treating living body tissue A control apparatus for use with a surgical instrument having an end effector that imparts respect to the biological tissue,
The control device has a sealing control mode in which power for sealing the living tissue is supplied to the treatment tool by heating the living tissue at a first temperature, and the living tissue is subjected to the first. It comprises at least one processor capable of each executing an incision control mode in which power for incising the living tissue is supplied to the treatment tool by heating at a second temperature higher than the temperature of the above.
The processor
By executing the incision control mode, the elapsed time after the end effector reaches the second temperature is calculated as an index value as an index of the temperature of the end effector.
Compare the index value with the threshold value and
A control device for determining the residual heat level of the end effector based on the result of comparison between the index value and the threshold value. The elapsed time is
The control device according to claim 1 , which is the elapsed time from the completion of the incision control mode. The threshold is
The first threshold value to be compared with the elapsed time and
It comprises a second threshold, which is compared to the level of heat denaturation in which the living tissue is heat denatured by contact with the end effector.
The processor
The heat denaturation level was calculated as the index value, and
Comparing the elapsed time with the first threshold,
Comparing the heat denaturation level with the second threshold,
Comparison result between the between the elapsed time first threshold value, and based on a result of comparison between said thermal denaturation level the second threshold value, determining said Zan'netsu level control device according to claim 1. The threshold is
A plurality of the incision control modes are provided according to at least one of the duration of execution of the incision control mode and the number of times the incision control mode is continuously executed.
The processor
Comparing the threshold value and the elapsed time at least corresponding to one of said duration and said number of the plurality of the threshold values, the control apparatus according to claim 1. The end effector is
A heater that generates heat in response to the supply of electric power,
With a pair of high frequency electrodes,
The control device
A thermal energy output unit that supplies thermal energy, which is the treatment energy, from the end effector to the living tissue by supplying the electric power to the heater.
The first aspect of claim 1, further comprising a high-frequency energy output unit that applies high-frequency energy, which is the treatment energy, from the end effector to the living tissue by supplying the electric power between the pair of high-frequency electrodes. Control device . The processor
The control device according to claim 1, wherein the notification unit is notified of information indicating the residual heat level. The processor
The control device according to claim 1, wherein at least one of the notification of information indicating a warning from the notification unit and the adjustment of the power supplied to the treatment tool are executed based on the determination result of the residual heat level. .. The processor
The control device according to claim 7 , wherein the higher the residual heat level, the more the electric power supplied to the treatment tool is suppressed. The processor
The control device according to claim 7 , wherein when the residual heat level exceeds a specific level, the supply of the electric power to the treatment tool is prohibited. The processor
The control device according to claim 7 , wherein when the residual heat level exceeds a specific level, the notification unit is notified of information indicating the warning. Wherein the processor is,
Prior Kifutome control mode, based on the Zan'netsu level judgment result, the adjusting power supplied to the treatment instrument control device according to claim 7. The processor
The control device according to claim 11 , wherein the control target value in the sealing control mode is changed based on the determination result of the residual heat level. The processor
At least one of the type and size of the living tissue is determined, and
When the sealing control mode is executed, the electric power supplied to the treatment tool is adjusted based on the determination result of the residual heat level and the determination result of at least one of the type and size of the biological tissue. The control device according to claim 11 . The end effector is
Equipped with a pair of high frequency electrodes
The control device
A high-frequency energy output unit that applies high-frequency energy, which is the treatment energy, from the end effector to the living tissue by supplying the electric power between the pair of high-frequency electrodes is further provided.
The processor
The control device according to claim 13 , wherein at least one of the type and size of the living tissue is determined by controlling the operation of the high-frequency energy output unit and passing a detection current from the end effector to the living tissue. .. The end effector is
A heater that generates heat in response to the supply of electric power,
With a pair of high frequency electrodes,
The control device
A thermal energy output unit that supplies thermal energy, which is the treatment energy, from the end effector to the living tissue by supplying the electric power to the heater.
A high-frequency energy output unit that applies high-frequency energy, which is the treatment energy, from the end effector to the living tissue by supplying the electric power between the pair of high-frequency electrodes is further provided.
The processor
In the sealing control mode, on the basis of the Zan'netsu level judgment result, selecting at least one of the thermal energy and the high-frequency energy as the treatment energy given to the body tissue, according to claim 11 Control device . The processor
When the residual heat level is the first level, both the thermal energy and the high frequency energy are selected as the treatment energy to be applied to the living tissue.
When the residual heat level is a second level higher than the first level, one of the thermal energy and the high frequency energy is selected as the treatment energy to be applied to the living tissue. 15. The control device according to 15. It is a residual heat determination method executed by the processor of the control device.
The processor
A sealing control mode in which power for sealing the living tissue is supplied to the treatment tool by heating the living tissue at the first temperature, and a second setting in which the living tissue is higher than the first temperature. By heating at the temperature of the above, it is possible to execute the incision control mode in which the electric power for incising the living tissue is supplied to the treatment tool.
The residual heat determination method is
By executing the incision control mode, the elapsed time after the end effector provided on the treatment tool reaches the second temperature is calculated as an index value as an index of the temperature of the end effector.
Compare the index value with the threshold value and
A method for determining residual heat for determining the residual heat level of the end effector based on the result of comparison between the index value and the threshold value. It is a residual heat judgment program that is executed by the processor of the control device.
The processor
A sealing control mode in which power for sealing the living tissue is supplied to the treatment tool by heating the living tissue at the first temperature, and a second setting in which the living tissue is higher than the first temperature. By heating at the temperature of the above, it is possible to execute the incision control mode in which the electric power for incising the living tissue is supplied to the treatment tool.
The residual heat determination program instructs the processor to execute the following:
By executing the incision control mode, the elapsed time after the end effector provided on the treatment tool reaches the second temperature is calculated as an index value as an index of the temperature of the end effector.
Compare the index value with the threshold value and
A residual heat determination program for determining the residual heat level of the end effector based on the comparison result between the index value and the threshold value.

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